Abstract:
:Detrusor instability is a urodynamic diagnosis made when the detrusor is shown objectively to contract, spontaneously or on provocation, during the filling phase of a cystometrogram while the patient is attempting to inhibit micturition. It often is responsible for symptoms of urgency, frequency, nocturia, urge incontinence, and nocturnal enuresis, but is not synonymous with any of them. Furthermore, it may be responsible for urinary incontinence which appears to be simple stress incontinence, and should be excluded before an operation for genuine stress incontinence is undertaken. Patients with mixed incontinence should have their detrusor instability treated before an attempt at surgical correction of stress incontinence is made. A number of therapeutic options exist for the unstable bladder. The simplest is bladder drill. My own preference is to start patients on bladder drill in conjunction with oxybutynin chloride 5 mg orally three times daily, with the plan of weaning them off the medication if possible in 3-6 months. Propantheline bromide in dosages of 15-30 mg orally four times daily also appears to be effective. Imipramine, in dosages of 25-50 mg orally twice daily, or up to 75 or 100 mg orally at night also may be helpful, especially if the patient suffers from nocturia or nocturnal enuresis. The effects of imipramine appear to be additive to those of other drugs, and this makes it a useful adjunct in therapy. Emepronium bromide and flavoxate hydrochloride appear to be less useful pharmacologic agents. The expected addition within the next few years of terodiline hydrochloride to the drugs available in the United States is likely to improve significantly our ability to treat detrusor instability. The use of prostaglandin synthetase inhibitors in women with perimenstrual exacerbations of their symptoms may be useful on a case-by-case basis. Patients who do not experience improvement with behavioral intervention and pharmacologic treatment may be candidates for electric stimulation therapy or surgery. The efficacy of electric stimulation therapy is diminished in many cases by poor patient acceptance. The most effective surgical treatment for refractory detrusor instability appears to be augmentation cystoplasty, which should be attempted only by a trained reconstructive urologist, and which should be reserved for the most refractory and difficult cases.
journal_name
Clin Obstet Gynecoljournal_title
Clinical obstetrics and gynecologyauthors
Wall LLdoi
10.1097/00003081-199006000-00021subject
Has Abstractpub_date
1990-06-01 00:00:00pages
367-77issue
2eissn
0009-9201issn
1532-5520journal_volume
33pub_type
杂志文章,评审abstract::Patient safety is a significant concern for healthcare providers. Involving physicians in clinical quality activities in obstetrics and gynecology can be difficult for many reasons including time demands, lack of knowledge of process improvement activities, or change fatigue due to failure of adequate implementation o...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e3181ec1b29
更新日期:2010-09-01 00:00:00
abstract::Using oral agents for induction of labor would reduce the need for repeated vaginal examinations; this is more acceptable to women and could reduce infection rates. A systematic review was conducted of 41 randomized trials comparing oral misoprostol to other induction agents. Oral misoprostol is effective at achieving...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-200609000-00023
更新日期:2006-09-01 00:00:00
abstract::The timely onset of labor and birth is an important determinant of perinatal outcome. Prolonged (postterm) pregnancy--defined as delivery at or beyond 42 weeks' gestation--complicates 10% of all gestations and is associated with increased risks to both fetus (stillbirth, macrosomia, birth injury, meconium aspiration s...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e31804c9b11
更新日期:2007-06-01 00:00:00
abstract::Maternal mortality is a complex problem requiring complex responses. Nevertheless, every intervention must operate through one of 3 pathways: preventing pregnancy, preventing complications, or preventing death when obstetric complications occur. We describe interventions following each pathway and assess their evidenc...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/GRF.0b013e3181a4bddb
更新日期:2009-06-01 00:00:00
abstract::Bacterial vaginitis is responsible for approximately 10 million office visits per year. This condition may disrupt marriages and cause psychologic stress that may be reflected in the individual's work and social life. Bacterial vaginitis also has been thought to lead to postpartum endometritis, pelvic cellulitis, pelv...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:
更新日期:1991-09-01 00:00:00
abstract::We live in a turbulant period with regard to interpersonal relationships. Individuals place great emphasis on their ability to form good relationships. It is a time of desiring and searching; desiring to be engaged in a rewarding relationship and searching for any principles which might promote such involvement. Obste...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00003081-197803000-00014
更新日期:1978-03-01 00:00:00
abstract::Although there are fairly wide variations AFV normally undergoes characteristic changes across gestation in which it increases from 10-20 ml at 10 weeks gestation to average 800 ml at 24 weeks. Little change occurs from then until near term when AFV begins to decrease, and large decreases can occur in postterm pregnan...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199706000-00005
更新日期:1997-06-01 00:00:00
abstract::Determining which women should undergo dual-energy x-ray absorptiometry testing should be based on rational screening criteria. Screening tests should be simple to perform, readily available, and very sensitive. Clinical risk factors have been proposed by numerous professional societies as a way to screen women for fu...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e3182a99814
更新日期:2013-12-01 00:00:00
abstract::In mammalian reproductive physiology, lactation follows pregnancy; growing evidence suggests that disruption of this physiology affects a woman's lifetime risk of metabolic disease. These differences may reflect lactation-induced mobilization of fat stores and modulation of maternal stress reactivity. In addition, con...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000155
更新日期:2015-12-01 00:00:00
abstract::Placental lesions identified in cases of stillbirth are of clinical interest and are frequently invoked as having a causal role. However, most of the placental changes found in stillbirth are also seen in liveborn pregnancies, and are of uncertain pathogenetic significance. Much of the literature addressing placental ...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e3181eb68fe
更新日期:2010-09-01 00:00:00
abstract::The advent of ultrasound fetal imaging and the evolution of dynamic imaging (real-time) methods have opened great new vistas in which fetal responses can be monitored with remarkable precision and clarity. Contained within this new wealth of information may lie the key to direct determination of the fetus at risk for ...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199503000-00006
更新日期:1995-03-01 00:00:00
abstract::Direct electronic urethrocystometry simultaneously records pressures in the bladder, proximal urethra, and abdomen in a patient at rest and under stress while the bladder fills with urine. It documents the presence or absence of detrusor contractions and is an essential part of the evaluation of patients with detrusor...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00003081-197809000-00008
更新日期:1978-09-01 00:00:00
abstract::The purpose of this paper is to assist the clinician in recognizing pelvic floor muscle dysfunction in women with vulvar symptoms, to provide general treatment algorithms, and to facilitate understanding of the scientific rationale behind appropriate treatment. In short, this paper is meant to provide a "how-to" guide...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/GRF.0000000000000135
更新日期:2015-09-01 00:00:00
abstract::This chapter will review the current modalities available to the clinician to screen for premalignant and malignant cervical lesions, which cast a broad net. The majority who test positive are not destined to suffer from or die from cervical cancer. Many who undergo screening and are triaged are young and subsequently...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/GRF.0000000000000026
更新日期:2014-06-01 00:00:00
abstract::In our proof-of-concept study of 1 patient with stage IIIC carcinosarcoma of the ovary, we discovered a rare mutation in the tumor suppressor, TP53, that results in the deletion of N131. Immunofluorescence imaging of the organoid culture revealed hyperstaining of p53 protein. Computational modeling suggests this resid...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/GRF.0000000000000516
更新日期:2020-03-01 00:00:00
abstract::Prospective studies that begin during pregnancy and follow the mothers and children into adolescence have shown that maternal mental illness during the antenatal and postpartum period can have long-lasting negative consequences on the developing child. The findings from these prospective studies and a discussion of th...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e3181b52930
更新日期:2009-09-01 00:00:00
abstract::Uterine leiomyomas pose a significant health issue to reproductive-age women. Many women desire uterine conservation, and previously safe and efficacious therapies have been limited. Magnetic resonance-guided focused ultrasound surgery is a new noninvasive therapy that has been proven to be both safe and efficacious i...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e318161e91f
更新日期:2008-03-01 00:00:00
abstract::Operative vaginal delivery has been maligned since the days of W.J. Little with the word "forceps" becoming nearly synonymous with "Birth Injury" and "Cerebral Palsy." However in his presentation to the Obstetrical Society of London in 1861, Little's emphasis was on difficult labors being the culprit in subsequent dis...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e31811eaa39
更新日期:2007-09-01 00:00:00
abstract::Müllerian duct anomalies (MDAs) are relatively common disorders that are particularly relevant in patients with infertility, recurrent pregnancy loss, or a history of preterm labor. Accurate characterization of MDAs is crucial to the implementation of appropriate treatment. Various imaging modalities have been used in...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e3181958439
更新日期:2009-03-01 00:00:00
abstract::Current findings continue to support the concept of a biologically defective decidua rather than a primarily abnormally invasive trophoblast. Prior cesarean sections increase the risk of placenta previa and both adherent and invasive placenta accreta, suggesting that the endometrial/decidual defect following the iatro...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000392
更新日期:2018-12-01 00:00:00
abstract::The postpartum period in women with diabetes or GDM allows both the physician and mother to relax from the intensive medical and obstetric management that has permitted, in most cases, a successful and joyous outcome. The role of the physician, however, must switch to a proactive and preventive mode to formulate a rep...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-200003000-00008
更新日期:2000-03-01 00:00:00
abstract::This article will review the basic principles of risk management, the role of the risk manager, and the importance of risk management in the patient safety movement as it pertains to obstetrics and gynecology. Several tools that are used by risk managers including risk assessments and root cause analyses will be used ...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000473
更新日期:2019-09-01 00:00:00
abstract::Rectovaginal fistulas and chronic anal sphincter lacerations are uncommon complications that are most often secondary to vaginal delivery, gynecologic surgery, and inflammatory bowel disease. In this chapter, we will review the pertinent anatomy, focusing on the 6 structures that should be considered during the repair...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e3181cf7488
更新日期:2010-03-01 00:00:00
abstract::The relationship between the clinical state of the cervix and spontaneous onset of labor has long been known. The cervix can be characterized by evaluating five parameters: effacement, dilatation, firmness, position, and level of the presenting part. The relative associations between successful labor induction and the...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199506000-00005
更新日期:1995-06-01 00:00:00
abstract::The role of Interventional radiologic procedures for the management of suspected placenta accreta spectrum (PAS) has evolved considerably over last 3 decades. In this article, the authors describe the various techniques of vascular occlusion for the management of PAS and provide a brief review of the literature examin...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000401
更新日期:2018-12-01 00:00:00
abstract::In this review I have briefly outlined some of the cellular and molecular reasons for dystocia. I have described the myogenic, that may control the normal progression of labor and explain inadequate uterine contractility associated with dystocia. I have placed particular emphasis on our studies of gap junctions and th...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-198703000-00004
更新日期:1987-03-01 00:00:00
abstract::In the last 10 years, expanded preconception carrier screening has become widely available and helps patients/couples make more informed decisions with regard to their reproductive options and facilitates more effective preconception planning, prenatal diagnosis, condition-specific counseling, and condition-specific c...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000437
更新日期:2019-06-01 00:00:00
abstract::The relevance of extraneous factors on fetal and neonatal respiratory gas exchange and acid-base balance must be considered when interpreting umbilical cord blood values. However, although many of these factors can alter these values to a minor degree, the clinical impact is negligible in the unstressed fetus. The mor...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199303000-00009
更新日期:1993-03-01 00:00:00
abstract::Embolic phenomena in pregnancy demand rapid investigation and treatment. Regardless, some patients will not survive due to the enormity of the insult. Optimally, such patients should be treated in tertiary care centers, but this is not always possible. ...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199009000-00013
更新日期:1990-09-01 00:00:00
abstract::The concept of early breast cancer as a palpable mass with limited secondary manifestations is rapidly changing. Thanks largely to mammography, a malignant breast neoplasm can be detected long before it forms a mass. Because cure rates in this stage are high, reliable means of early detection and diagnosis are of deep...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00003081-197506000-00012
更新日期:1975-06-01 00:00:00